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General NPI Number Information
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NPI Number | 1154561140
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Entity Type | Organization
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Legal Business Name | F THACHER CARTER PSYD PC
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 105 FIR ST SUITE 332
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City | LA GRANDE
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State | OR
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Zip | 97850-2661
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Country | US
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Telephone | 541-910-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 63670 OWSLEY CANYON RD
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City | LA GRANDE
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State | OR
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Zip | 97850-5177
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Country | US
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Telephone | 541-962-7491
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FREDERICK THACHER CARTER
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Credential | PSYD,
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Telephone | 541-962-7491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1172
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License Number State | OR
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